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'`1eC)R& CERTIFICATE OF LIABILITY INSURANCE
<br />111
<br />DATE(MMIDD/YYYY)
<br />1 11/10/2017
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />SI
<br />UColorado, LLC Prof Liab
<br />P.O. Box 7050
<br />Englewood CO 80155
<br />CONTACT
<br />Kath Star
<br />PHONE FAX
<br />800-873-8500 IAM, Ni
<br />EMAILFss
<br />INSURERS AFFORDING COVERAGE
<br />NAIL #
<br />INSURERA:XL Specialty Insurance Company
<br />37885
<br />INSURED INTERCON35
<br />INSURER B:TravelersIndemnity Company of CT
<br />25682
<br />Interest Consulting Group
<br />P.O. Box 18330
<br />INSURER C:Travelers Property Cas. Co. of Amer
<br />25674
<br />Boulder CO 80308
<br />INSURER D :
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1289637119 RFVISION NIIMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSUSK
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIVYYY
<br />POLICY EXP
<br />MM/DDIVVYV
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X OCCUR
<br />Y
<br />Y
<br />6806H441235
<br />11/14/2017
<br />11/14/2018
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />X
<br />AGGREGATE LIMITAPPLIES PER
<br />POLICY DX PEC LOG
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />$
<br />OTHER',
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />8AOJ093233
<br />11/14/2017
<br />11/14/2018
<br />COMBI E S ELIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />BOD I I I NJ URY(Per person)
<br />$
<br />ALL OAUTOS�ED AUTODULED
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />CUP1330T362
<br />11/14/2017
<br />11/14/2018
<br />EACH OCCURRENCE
<br />$4,000,000
<br />_
<br />AGGREGATE
<br />$4,000,000
<br />E%CESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION$0
<br />$
<br />O
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />y
<br />UB133OT934
<br />11/14/2017
<br />11/14/2018
<br />X PR OTH-
<br />STATUTE
<br />ERE
<br />_
<br />EL EACH ACCIDENT
<br />_
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />EL.DISEASE - POLICY LIMIT
<br />$1,000,000
<br />A
<br />Professional Liability
<br />Pollution Liability Ind
<br />Claims Made
<br />Y
<br />DPR9919387
<br />11/14/2017
<br />11/14/2018
<br />Per Claiint $2,000,000
<br />Annual Aggregate $5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and
<br />exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under
<br />General Liability; Designated Insured under Automobile Liability; and Additional Insured's under Umbrella / Excess Liability but only with
<br />respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. The General Liability,
<br />Automobile Liability, Umbrella/Excess insurance applies on a primary and non-contributory basis. A Blanket Waiver of Subrogation applies
<br />for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Purchasing Department
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />I, k y(
<br />Oy
<br />© 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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